I have posted elsewhere here about how biteguards, physical therapy, dental work, and botox won't give more than temporary relief unless you can stop the TMD activity.

I agree with Dr.Davidson at UC San Diego that usually it is due to stress response. http://health.ucsd.edu/specialties/surgery /davidson/consults/tmj.htm

I also think it can be a response to chronic pain, or hereditary, or due to a bad bite (malocclusion that a dentist can fix).

Mostly, i get the impression that stopping the grinding or clenching is the most important goal, and all the bite guards and dental restoration in the world wasted if you continue to make the activity more chronic and destructive of your jaw and TMjoint. I also suspect that those who estimate that 20% have TMD, only 5% get pain (mostly local), and maybe 1% are getting disabled with migraine like attacks, triggered migraines, hemiplegic migraine or migraine like attacks that can occasionally be completely disabling, with additional symptoms from ruined sleep, constipation, spastic colon, pulled muscles, and no recovery time between attacks.

I got my pain doc to botox my masseter (jaw) muscles, and have a little less pain and attacks. I need to know the best protocol of this still-experimental treatment - I think 2 shots to the bottoms of the masseters might not be enough. I found that putting a 2 inch long piece of low odor allergenic paper bandage tape over 90% of my nostril openings at bedtime seems to prevent or defer the worst attacks, which I thought up from reading that mouth breathers probably can't brux much. Muscle relaxants and pain killers and bite guards and TMJ athroscopic flush no longer work.

Does somebody have more info than me hopefully? Any way I can teach my pain doc how to botox more effectively and at the right intervals so that I don't lose the masseters completely, but paralyze them more than I have with my first set of shots? How do you space the shots?

I've already been diagnosed as central sensitization meaning that curing the cause is no use anymore because my brain's pathways have been recruited to make the cycle self-sustaining, but the botox and taped nostrils have given me a little hope. However, I still get attacks as strong as the worst hemiplegic migraines, without enough time to recover before the next attack.

I
I hope someone can add to my scanty information!